Abstract
For the clipping of aneurysmal neck with preservation of main branches or perforators of cerebral arteries, we have used endoscope-assisted technique for 51 aneurysms over the last five years.
Aneurysms clipped with the assistance of endoscope include 8 involving the internal carotid-ophthalmic artery, 26 involving the internal carotid-posterior communicating artery (IC-PC) and 11 involving the basilar artery. Thirty-two aneurysms (63.1%) were non-ruptured among them. Four types of rigid endoscope (Olympus and GAAB: angle; diameter, 0; 4mm, 30; 2, 7mm, 70; 4mm, and 110; 4mm, respectively) were applied to observe the arterial branches or perforators before, during, and after neck clipping. Some aneurysms were clipped under the microscope following endoscopic observation, and some were clipped under the microscope during the observation by endoscope, whose head was seated near the aneurysms.
Some branches and many perforators that were not identified preoperatively by angiography and intraoperatively by microscope could be preserved under the endoscopic observation. No patients angiographically tested had incomplete clipping. Most patients had an uneventful course, but 1 with IC-PC aneurysm revealed temporary oculomotor palsy. There were initially several problems to be solved: 1) the poorer resolution of picture obtained by endoscope compared with that by microscope; 2) the disturbance of operative handling by using endoscope system; 3) inability of synchronized view between endoscope and microscope. These have been mostly solved. The rigid-type endoscope gives better resolution, electromagnetic-powered point setter makes both hands free from handling of endoscope and a new microscope that has an overlay system has been produced by a company (Olympus, ME 8000).
These safer and more satisfactory results indicate that endoscope assisted technique could be applicable not only for the intraventricular surgery as we have discussed but for the clipping of aneurysms.
